SRZ Op Autumn LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

SRZ OP AUTUMN LLC

Doing business as

Polaris Health & Wellness of Autumn Terrace

Practice address

6124 Raytown Rd
Raytown, MO 64133

Phone

(816) 358-8222

NPI assigned

May 17, 2018

Organization subpart

Yes

Parent organization

SRZ OP HOLDINGS LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samuel Goldner

Title

Authorized Person/Official

Phone

(347) 677-0448

Specialties & licenses 1

Addresses

Other names 1

• Polaris Health & Wellness of Autumn Terrace Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663286400000",
    "number": "1366932014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 HERRICK DR",
            "city": "LAWRENCE",
            "state": "NY",
            "postal_code": "115591528",
            "telephone_number": "929-928-0307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6124 RAYTOWN RD",
            "city": "RAYTOWN",
            "state": "MO",
            "postal_code": "64133",
            "telephone_number": "816-358-8222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRZ OP AUTUMN LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SRZ OP HOLDINGS LLC",
        "enumeration_date": "2018-05-17",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-16",
        "status": "A",
        "authorized_official_last_name": "GOLDNER",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "AUTHORIZED PERSON/OFFICIAL",
        "authorized_official_telephone_number": "347-677-0448"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Polaris Health & Wellness of Autumn Terrace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Raytown, MO
• Providers in Raytown, MO by specialty
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.